Life out of death?

Donations after circulatory death. Dealing with death is a large part of our work. It is never easy and I have always found dealing with the end of life emotionally draining.

The potential for organ donation can ensure something positive comes out of it; yet the processes involved, including the uncertainty as to whether a patient who is deemed suitable for donation will eventually donate, exert their own toll on the staff who do the asking and the family who have to consider it.

It was thus with interest I read Clare Tordoff’s article on the potential for donation after cardiac death in the May issue of JICS. She and her colleagues looked at 100 consecutive patients admitted following out of hospital cardiac arrest in a tertiary critical care unit. Fifty-three did not survive to hospital discharge, 13 died suddenly and 3 died on the wards following discharge.

“14 out of 29 were deemed suitable for non-heart beating organ donation – only one donated”

One went on to donate after brain stem death leaving 36 who had their active treatment withdrawn. Fourteen of the 29 referred to the transplant team were deemed medically suitable for non-heart beating organ donation. Of those only one went on to donate organs.

Seven families declined donation and of the others, 6 did not die within the 3 hour window to donation.

The authors note the resource implications of having the transplant team on standby even when there may be little prospect of the patient going onto donate organs.

“A dialogue with the transplant team may result in a better donation to call out ratio”

In discussing current practice, where all patients who have treatment withdrawal should be referred to UK transplant, they debate a more selective approach, where a dialogue with the transplant team may result in a better donation to call out ratio.

The authors advocate further study with the aim of producing a validated tool that would predict who is likely to meet the criteria for donation after cardiac death. While any such tool is unlikely to be a crystal ball I am sure that it would be helpful to all parties.

It may even persuade more families in the emotional maelstrom that surrounds treatment withdrawal to consider consenting for organ donation.

Source: Outcomes following out-of-hospital cardiac arrest: What is the potential for donation after circulatory death? By Claire C Tordoff, Andrew R Bodenham. Journal of the Intensive Care Society May 2016 17: 97-102.